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BCBSGa prepares to serve same-sex couples

July 14, 2015

Blue Cross and Blue Shield of Georgia (BCBSGa) has been monitoring the rapidly changing landscape relating to same-sex spouses. The Supreme Court recently ruled that same-sex couples have a constitutional right to marry in all states. It also requires states to recognize same-sex marriages that were validly performed in other states.

Even before the Supreme Court ruling, we offered our groups the opportunity to cover same-sex spouses. Our standard group certificates allow for same-sex married couples to enroll, if they live in a state that recognizes same-sex marriage. This would include contracts issued in a state that did not previously recognize same-sex marriage.

BCBSGa will allow insured and self-insured plans in any state to enroll same-sex spouses. But it's generally up to the group, in the absence of a state insurance mandate, to decide whether to offer domestic partner benefits or same-sex marriage benefits.

Accordingly, we will administer the plan based on the group's direction. Employees with questions about their group coverage eligibility should check the terms of their employer’s plan. We expect employers likely will review their benefit offerings and internal policies as they relate to the court’s ruling. And because of the ruling, we will prepare to serve more same-sex couples as consumers.

Note that plans sponsored by state and local governments that offer spousal benefits must cover same-sex spouses who wish to enroll after the Supreme Court’s ruling, because it requires states to recognize same- sex marriage.

Here are some Frequently Asked Questions, if you’d like additional information. And of course, you can contact Broker Services or your sales representative, if you have questions.

Frequently Asked Questions for Group BusinessQ: Are employers who offer spousal benefits now required to offer spousal health insurance benefits for same-sex couples who are married?

A: Blue Cross and Blue Shield of Georgia (BCBSGa) will allow insured and self-insured plans in any state to enroll same-sex spouses.In the group market in absence of a state insurance mandate, whether fully insured or self-insured, it is generally the group’s decision whether to offer domestic partner benefits or same-sex marriage benefits.

Plans sponsored by state and local governments that offer spousal benefits must cover same-sex spouses who wish to enroll after the Supreme Court’s ruling, because it requires states to recognize same-sex marriage.

If a non-government plan did not have enrollment rules restricting same-sex marriage coverage prior to the Supreme Court ruling on June 26, 2015, the provisions of the plan as expressed in our group certificates would make same-sex married couples eligible to enroll as of that date, if they live in a state that did not previously recognize same-sex marriage. If the couple lives in a state that did recognize same-sex marriage prior to the Supreme Court ruling, the couple would have been eligible to enroll prior to the ruling.

Q: If an employer previously had an enrollment rule restricting coverage for same-sex married couples, can it continue that restriction?

A: In the group market in absence of a state insurance mandate, whether fully insured or self-insured, it is generally the group’s decision whether to offer domestic partner benefits or same sex marriage benefits. Groups should consult their own legal advisors as to whether they should continue any restriction on coverage for same-sex marriage.

It is important to note that the Supreme Court ruling focused on the obligation of states to allow and recognize same-sex marriage. State and local government plans are required by the ruling to offer coverage to same-sex married couples if they allow opposite sex spouses to enroll. Employers with group plans regulated by ERISA should consult with their attorneys about whether to make any changes.

BCBSGa will administer the plan according to the group plan sponsor’s direction. Members with questions regarding their group coverage eligibility should check the terms of their employer’s plan.

It is likely employers will be reviewing their benefits offerings and internal policies as they relate to the court’s ruling.

Q: If an ERISA plan does not have an enrollment rule restricting coverage for same-sex married couples, can it add that restriction now?

A: In the group market in absence of a state mandate, whether fully insured or self-insured, it is generally the group’s decision whether to offer domestic partner benefits or same-sex marriage benefits. Groups should consult their own legal advisors as to whether they may add any restriction on coverage for same-sex marriage.

It is important to note that without a previous restriction on same-sex marriage coverage, our certificates allowed for coverage of same-sex marriages, if they were recognized in the state where the couple resided. For couples residing in states where same-sex marriages were not recognized before the Supreme Court ruling on June 26, 2015, they can now begin the enrollment process accordingly.

Q: When can same-sex spouses be enrolled?

A: In a plan that does not exclude coverage for same-sex spouses, if the couple was married and living in a state that recognized the marriage prior to the Supreme Court ruling, the ruling does not create a special enrollment opportunity, because the couple could have already enrolled. If the couple was married in a state that allowed same-sex marriages, but lived in a state that prior to the ruling did not allow or recognize same-sex marriages, a special enrollment period is created based on the ruling. The qualifying event date was June 26, 2015, and the typical 30-day enrollment period would normally occur from that date. BCBSGa is allowing an extended special enrollment period from June 26 — July 31, 2015.

Of course, couples getting married after the date of the Supreme Court ruling would experience a qualifying event based on the date of the marriage.

Q: If a same-sex couple was legally married years ago in another state, but lived in a state that did not previously recognize the marriage as valid, why is there a special enrollment if they are already married? Can they be told they can only enroll at open enrollment?

A: There is a special enrollment period because the marriage was not valid in the state where they lived, and they could not enroll as spouse under the terms of the health plan. BCBSGa treats the fact that the marriage is now legal in their state of residence as a new marriage because of the benefits of marriage that the ruling bestows.

Q: If a same-sex couple was legally married in another state, lived in a state that did not previously recognize the marriage as valid, but is currently enrolled under the plan as a domestic partner, is there a special enrollment?

A: Yes, because the marriage was not valid in the state where they lived, they could not enroll as spouse under the terms of the health plan. BCBSGa treats the fact that the marriage is now legal in their state of residence as a new marriage because of the benefits of marriage that the ruling bestows. The new marriage is a qualifying event regardless of prior enrollment, particularly because of new opportunities to enroll dependents that may be available.

Q: Given the Supreme Court’s ruling guaranteeing a nationwide right to same-sex marriage, will an employee who currently has coverage for his/her domestic partner now have to get married in order to keep the coverage?

A: BCBSGa will administer the plan according to the group plan sponsor’s direction. Members with questions regarding their group coverage eligibility should check with the terms of their employer’s plan.

While the ruling does not change existing plan terms related to domestic partner benefits, it is likely employers will be reviewing their benefits offerings and internal policies as they relate to the Supreme Court’s ruling.

Q: Will employers discontinue domestic partner benefits?

A: It will be up to each employer. It is likely employers will be reviewing their benefits offerings and internal policies as they relate to the Supreme Court’s ruling. BCBSGa will administer the plan according to the group plan sponsor’s direction.